Provider Demographics
NPI:1902829005
Name:NOVAK, ALBERT JOSEPH (DO)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:JOSEPH
Last Name:NOVAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 863407
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3407
Mailing Address - Country:US
Mailing Address - Phone:941-917-8454
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:5880 RAND BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-5118
Practice Address - Country:US
Practice Address - Phone:941-917-2300
Practice Address - Fax:941-923-1453
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12417207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1902829005Medicaid
NC8913434Medicaid
NC13434OtherNCBCBS
SCN01508Medicaid
NC8913434Medicaid
P00102935Medicare PIN
NC1902829005Medicaid
SCN01508Medicaid